How Your Bra can affect Your Posture and Back, Shoulder and Neck Pain

October 26, 2017

By Sean Treharne, DPT

For the record, I am a male Doctor of Physical Therapy. I consider myself to be an expert in human anatomy and biomechanics and spend 40+ hours per week helping my patients overcome a variety of painful conditions. However, I am also the first to admit that I am not an expert in a lot of other things. Sometimes I get questions that involve alternative medicine or the latest health fad that stray outside my area of expertise and I will readily admit when I cannot give the best answer. An important question one patient asked me recently was: “Does my bra contribute to my pain?”. I admitted that I had never worn a bra and might not have the best answer for her. So I went out looking for an expert opinion. I spoke with Helen Serth, owner of a women’s boutique in Wilmington, Delaware called Bare Essentials that specializes in professional bra fittings.

Helen trained under “fit-specialist” Frederica Zappe and works with a staff who has on average 4-5 years of experience in bra fitting. She is also a Crossfit coach that has a passion for making women feel better about themselves and gets to see this daily at Bare Essentials. “I especially enjoy seeing the transformation of a woman who walked in slumped over, lacking confidence walking out upright and feeling confident”. As I talked with Helen, I started to connect the dots and see how a poor bra fit can contribute to common musculoskeletal problems. Using both Helen’s and my expertise, I will outline three of the most common areas of pain that I treat and how bras can help or hurt them.

Low back pain

Most people are familiar with (and rarely use) “proper body mechanics” when lifting. Imagine trying to lift a box.

Good Body Mechanics to lift a box

Bad lifting Mechanics

Good mechanics would be standing right next to the box, squatting down, keeping your back straight, and then standing up.

Bad mechanics would be standing a foot away from the box, bending your back, and then trying to stand back up straight with the box.

This same principle applies to carrying your own body weight. When a poorly fit bra does not offer support and causes your head, shoulders, and neck to lean forward, it shifts your entire center of mass forward. The further your center of mass shifts forward in relation to your base of support (your feet when standing and buttocks when sitting), the more strain is placed on the muscles and ligaments in the low back that keep your upright. Helen recommends getting re-measured for a bra at least once per year. Over the course of one year, both the human body and the elasticity of the bra can change drastically and change the demands placed on your low back.

Neck pain

Slouched sitting will have you looking straight down…

…unless you extend your neck to look straight forward

Have you ever sat in the front row of a movie theater? Walked out with a sore neck from looking up throughout the entire film? That is because prolonged extension of the neck is associated with cervical spine joint compression, pinched nerves, and strained neck muscles.

When the thoracic spine (mid back) becomes curved forward into that dreaded “slouched” posture, your cervical spine will naturally be put in a position that will have you looking straight down at the floor. To correct for this we will extend our neck so that we can look directly forward.

Unfortunately, this exact posture is common in many of my patients. I always come back to the movie theater analogy and explain that they are basically sitting in the front row all day long, no wonder they have neck pain! According to Helen, the most commonly mis-sized aspect of a bra is the band size, which is the primary support structure. An improperly fit band will cause some women to feel like they have to slouch forward. “Straps should do about 10% of the work and the band should do most of the rest. When trying on a bra it should only be able to be pulled about two inches off the back. The band should be fit on the largest size on that bra so you can use the other hooks to tighten it as the elasticity fades.” You can do a quick check of your own strap now, according to Helen, “A lot of women come in with the band riding up their back, it should be straight across. When a band starts to ride up it places most of the weight on the shoulder and makes you slouch”.

Shoulder pain

Slouched posture limits arm movement

Upright posture allow for full arm movement

The shoulder at its most basic level is a ball and socket. The “ball” (end of humerus, or arm bone) sits in a shallow “socket” (the outside aspect of the shoulder blade). If the shoulder blade tilts forward (imagine shrugging your shoulders forward), there is less space for the ball to move around in the socket. Here is a quick demonstration you can do yourself right now: First, slouch and push your shoulders forward. Then try to lift one arm up over your head.

You will likely feel tightness in the top of your shoulder and might not even be able to lift your arm all the way up. Lower your arm.

Then, stand up straight and pull your shoulders back slightly. Lift your arm straight up again and you will notice how there is less tightness and you might even be able to lift higher. With this simple movement, you can see that posture plays a huge role in the health and mobility of the shoulder.

The compression that you felt on the top of your shoulder is called shoulder impingement. It is a common shoulder movement disorder that can lead to subacromial bursitis, bicipital tendinitis, and rotator cuff tears. Helen has found that when a woman does not get enough support, her shoulders will be pulled forward. “We don’t get hung up on the size of a cup because it might give a particular body image…When getting fit, do not pay attention to numbers, just find the right fit”. She also notes that cup size is not the only aspect of cup support. “Sometimes having multiple seams in a cup rather than a seamless can provide the right amount of support, it’s not all about cup size”.

As you can see, there is much more to fitting a bra than just numbers. Sometimes it takes a trained eye to find the right fit, just as it takes a trained eye to fix painful conditions. Helen and I both agreed that the most valuable service we provide is education. Helping our patients and customers to understand how their body works can help prevent some of the common problems seen above.